SurgeryPerioperative β-blocker withdrawal and mortality in vascular surgical patients☆
Section snippets
Study population
A list of consecutive vascular surgical patients at a university hospital (University of Pennsylvania Medical Center) between January 1, 1995, and September 30, 1995, was obtained by a computerized search of the medical records system with use of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes, which included endarterectomy (38.1), resection of vessel with anastomosis or replacement (38.3, 38.4), other shunt or vascular bypass (39.2),
Prevalence of β-blocker administration and discontinuation
Sixty-one of 222 vascular surgical patients (27%) in the first cohort were receiving β-blockers before surgery. Fifty-five patients had documented use of β-blockers as outpatients and the other 6 received β-blockers in the inpatient preoperative period. β-Blockers were discontinued in 6 (10%) of 61 patients who received β-blockers preoperatively.
All 79 patients in the second cohort received preoperative β-blockers (by design). β-Blockers were discontinued in 2 (2.5%) patients.
Patient demographics and surgery type
Of the 140
Discussion
The results of our study suggest an increased risk of mortality and cardiovascular events associated with β-blocker discontinuation in vascular surgery patients, a group of patients with a relatively high prevalence of coronary artery disease and risk factors for perioperative morbidity and mortality. In evaluating the relationship between inpatient postoperative mortality and β-blocker discontinuation, we have tried to account for potential confounders that may have been associated with
Acknowledgements
We thank Jennifer M. Wolf, MD, and Deborah Carson, RN, BSN, MPH, for their assistance in the collection of data and Ms Sandra Barile for assistance in preparation of this manuscript.
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Reprint requests: Jonathan B. Shammash, MD, Cornell Internal Medicine Associates, New York Presbyterian Hospital–Cornell Medical Center, 1484 First Ave, Second Floor, New York, NY 10021.E-mail: [email protected]